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Post-traumatic stress disorder appears to be linked to heart disease, according to a study published Wednesday by Emory University scientists.

Tracking the health of 562 male twins who served in Vietnam, researchers found that those with PTSD were more than twice as likely to develop heart disease as those who didn’t have the disorder.

The study didn’t explain why, but it did indicate that those with PTSD had overall poorer physical health even when researchers accounted for different lifestyle factors such as smoking, drinking and physical activity.

“This study provides further evidence that PTSD may affect physical health,” said Dr. Gary Gibbons, director of the National Institutes of Health’s National Heart, Lung, and Blood Institute.

“This has illuminated the whole idea of stress and heart disease. While this notion has been popularly accepted — that stress is related to heart disease — it’s been hard to study. We now think those with PTSD may be at increased risk for long-term vascular events,” said Dr. Viola Vaccarino, chairwoman of the epidemiology department at Emory’s Rollins School of Public Health.

The researchers followed for 13 years the heart health of 340 identical and 222 fraternal twins who deployed to Vietnam. Heart disease was found in nearly 23 percent of those who had PTSD but in only 9 percent of those who did not have the condition.

In cases where one twin had PTSD and the other did not, the incidence of heart disease was almost double in those with PTSD, 22 percent, compared with those who did not, 13 percent.

Twins were used in the study because they allow researchers to account for the influences of genes and environment, Vaccarino said.

The Emory study follows another published in March by University of California Los Angeles researchers who found that patients diagnosed with PTSD had a higher risk of developing insulin resistance and metabolic syndrome, both precursors to heart disease and diabetes.

According to that study, which reviewed the medical records of more than 200,000 veterans, those with PTSD had a “significantly higher risk” of developing insulin resistance, which can lead to hardening of the arteries, and metabolic syndrome, a cluster of conditions that includes increased blood pressure, high blood sugar levels, excess body fat and abnormal cholesterol levels.

Vaccarino said those with PTSD should be aware of the possible link and consciously engage in a healthy lifestyle to offset the risk.

“It’s important that individuals with PTSD or exposed to trauma work hard to reduce the risk by doing things we know that work, like engaging in physical activity, eating well and not smoking,” she said.

UCLA researchers concluded the same. “Because insulin resistance and metabolic syndrome can be reversed during their early states with lifestyle modifications, including diet and exercise, it’s important that all patients at risk be identified early on,” said Dr. Ramin Ebrahimi, co-lead investigator on the UCLA study.

The findings of the Emory University study appeared Wednesday in the online Journal of the American College of Cardiology.

The UCLA study results were presented March 7 at an American College of Cardiology meeting in San Francisco.